PHTLS Pre & Post Test Mastery Assessment
Actual Exam – Complete Questions and
Answers with Detailed Rationales – Pass
Guaranteed – A+ Graded
Section 1: Trauma Assessment & Scene Management
Q1: You arrive on the scene of a high-speed motor vehicle collision. The vehicle struck
a utility pole, and the front end is severely deformed. The driver is still inside,
unconscious. What is the most appropriate first action regarding the scene?
A. Immediately cut the seatbelt and extract the driver to assess for life threats.
B. Ensure the vehicle is stabilized and check for downed power lines before
approaching.
C. Apply a cervical collar and initiate primary survey through the window.
D. Wait for fire department personnel to arrive before making any contact with the
patient.
Correct Answer: B
Rationale: The best answer is B. Scene safety and mechanism of injury assessment
happen before patient contact; ensuring there are no electrical hazards and the vehicle
is stable prevents rescuer injury.
Q2: Which of the following mechanisms of injury most strongly suggests the need for
immediate transport to a trauma center, regardless of the patient's initial vital signs?
A. A fall from a standing height onto concrete in an elderly patient.
B. A low-speed lateral impact vehicle collision with a deployed airbag.
C. An ejection from a vehicle during a high-speed rollover crash.
D. A vehicle collision with a pedestrian where the patient was struck but not thrown.
Correct Answer: C
Rationale: This choice is correct because an ejection from a vehicle is a high-energy
mechanism associated with severe multisystem trauma and meets trauma center
criteria due to the force involved.
Q3: During the primary survey of a trauma patient, you note massive external
hemorrhage from a leg laceration. The patient is gasping for air. According to the
XABCDE approach, what is your immediate priority?
,A. Perform a jaw thrust to open the airway.
B. Apply a tourniquet to control the leg bleeding.
C. Check for bilateral breath sounds.
D. Assess the patient's mental status (Disability).
Correct Answer: B
Rationale: The best answer is B because "X" stands for exsanguinating hemorrhage;
catastrophic bleeding must be controlled immediately before addressing the airway, as
the patient will die from blood loss faster than hypoxia.
Q4: You are assessing a 32-year-old male who was struck in the abdomen by a
baseball bat. He is conscious but anxious. His skin is pale and diaphoretic. His blood
pressure is 110/80 mmHg, pulse is 110 beats/min, and respirations are 22 breaths/min.
Which class of hypovolemic shock is this patient most likely in?
A. Class I
B. Class II
C. Class III
D. Class IV
Correct Answer: B
Rationale: This choice is correct because the patient exhibits tachycardia, mild
tachypnea, and signs of sympathetic stimulation (pale, diaphoretic) with a maintained
systolic blood pressure, which aligns with a 15–30% blood loss (Class II).
Q5: Which of the following sets of vital signs meets the standard physiological criteria
for immediate trauma team activation (Step 1 of the Trauma Decision Scheme)?
A. GCS 14, BP 118/70, RR 18.
B. GCS 15, BP 132/80, RR 16.
C. GCS 13, BP 88/60, RR 24.
D. GCS 15, BP 140/90, RR 20.
Correct Answer: C
Rationale: This choice is correct because a GCS ≤ 13, SBP < 90 mmHg, and RR < 10
or > 29 (or in this case, RR 24 plus the other findings, specifically the GCS and BP) are
the specific physiological triggers; this patient has a GCS of 13 and hypotension.
Q6: A patient has been involved in a rollover motor vehicle crash. He complains of neck
pain and has tenderness to palpation over the cervical spine. His Altered mental status
is GCS 15. What should you assume regarding his spinal status?
A. The cervical spine is cleared because he has no distracting injury.
B. The cervical spine is cleared because he is not intoxicated.
C. The cervical spine is injured until proven otherwise by imaging and clinical exam.
D. The cervical spine is likely stable because he was wearing a seatbelt.
, Correct Answer: C
Rationale: The best answer is C because in the prehospital setting, a traumatic
mechanism combined with midline cervical tenderness mandates spinal immobilization
and assumption of injury until a full evaluation can rule it out.
Q7: You are transporting a stable trauma patient with isolated orthopedic injuries to a
local hospital. The transport time is 15 minutes. Suddenly, the patient becomes
confused, his radial pulse becomes barely palpable, and his skin becomes cool and
clammy. What is the most appropriate change in management?
A. Continue transport at current speed but reassess vitals in 5 minutes.
B. Immediately divert to the nearest trauma center, even if it is past the local hospital.
C. Stop the ambulance, initiate a full secondary survey, and then proceed.
D. Increase oxygen flow rate and continue to the local hospital.
Correct Answer: B
Rationale: This choice is correct because the patient's decompensation indicates a
delayed response to injury (likely internal hemorrhage) requiring a higher level of
definitive care; the "load and go" decision must be re-evaluated based on changing
patient status.
Q8: During the secondary survey, you encounter a patient with a "seat belt sign" across
the abdomen. What specific injury should you suspect and investigate?
A. Lumbar spine fracture
B. Hollow viscus injury (small bowel)
C. Flail chest
D. Traumatic brain injury
Correct Answer: B
Rationale: This choice is correct because the seat belt sign is a marker of significant
force applied to the abdomen, which is strongly associated with injuries to the hollow
organs, particularly the small bowel and mesentery.
Q9: A construction worker falls approximately 25 feet onto concrete. He is awake but
complaining of back pain. His vital signs are stable. Why is the mechanism of injury
(MOI) significant in this case?
A. Falls greater than 20 feet are automatically considered "load and go" regardless of
vitals.
B. The energy transmission is sufficient to cause spinal, pelvic, or internal injuries
despite normal vitals.
C. MOI is only used for pediatric patients, not adults.
D. Stable vital signs rule out any significant injury from this height.
Correct Answer: B
Actual Exam – Complete Questions and
Answers with Detailed Rationales – Pass
Guaranteed – A+ Graded
Section 1: Trauma Assessment & Scene Management
Q1: You arrive on the scene of a high-speed motor vehicle collision. The vehicle struck
a utility pole, and the front end is severely deformed. The driver is still inside,
unconscious. What is the most appropriate first action regarding the scene?
A. Immediately cut the seatbelt and extract the driver to assess for life threats.
B. Ensure the vehicle is stabilized and check for downed power lines before
approaching.
C. Apply a cervical collar and initiate primary survey through the window.
D. Wait for fire department personnel to arrive before making any contact with the
patient.
Correct Answer: B
Rationale: The best answer is B. Scene safety and mechanism of injury assessment
happen before patient contact; ensuring there are no electrical hazards and the vehicle
is stable prevents rescuer injury.
Q2: Which of the following mechanisms of injury most strongly suggests the need for
immediate transport to a trauma center, regardless of the patient's initial vital signs?
A. A fall from a standing height onto concrete in an elderly patient.
B. A low-speed lateral impact vehicle collision with a deployed airbag.
C. An ejection from a vehicle during a high-speed rollover crash.
D. A vehicle collision with a pedestrian where the patient was struck but not thrown.
Correct Answer: C
Rationale: This choice is correct because an ejection from a vehicle is a high-energy
mechanism associated with severe multisystem trauma and meets trauma center
criteria due to the force involved.
Q3: During the primary survey of a trauma patient, you note massive external
hemorrhage from a leg laceration. The patient is gasping for air. According to the
XABCDE approach, what is your immediate priority?
,A. Perform a jaw thrust to open the airway.
B. Apply a tourniquet to control the leg bleeding.
C. Check for bilateral breath sounds.
D. Assess the patient's mental status (Disability).
Correct Answer: B
Rationale: The best answer is B because "X" stands for exsanguinating hemorrhage;
catastrophic bleeding must be controlled immediately before addressing the airway, as
the patient will die from blood loss faster than hypoxia.
Q4: You are assessing a 32-year-old male who was struck in the abdomen by a
baseball bat. He is conscious but anxious. His skin is pale and diaphoretic. His blood
pressure is 110/80 mmHg, pulse is 110 beats/min, and respirations are 22 breaths/min.
Which class of hypovolemic shock is this patient most likely in?
A. Class I
B. Class II
C. Class III
D. Class IV
Correct Answer: B
Rationale: This choice is correct because the patient exhibits tachycardia, mild
tachypnea, and signs of sympathetic stimulation (pale, diaphoretic) with a maintained
systolic blood pressure, which aligns with a 15–30% blood loss (Class II).
Q5: Which of the following sets of vital signs meets the standard physiological criteria
for immediate trauma team activation (Step 1 of the Trauma Decision Scheme)?
A. GCS 14, BP 118/70, RR 18.
B. GCS 15, BP 132/80, RR 16.
C. GCS 13, BP 88/60, RR 24.
D. GCS 15, BP 140/90, RR 20.
Correct Answer: C
Rationale: This choice is correct because a GCS ≤ 13, SBP < 90 mmHg, and RR < 10
or > 29 (or in this case, RR 24 plus the other findings, specifically the GCS and BP) are
the specific physiological triggers; this patient has a GCS of 13 and hypotension.
Q6: A patient has been involved in a rollover motor vehicle crash. He complains of neck
pain and has tenderness to palpation over the cervical spine. His Altered mental status
is GCS 15. What should you assume regarding his spinal status?
A. The cervical spine is cleared because he has no distracting injury.
B. The cervical spine is cleared because he is not intoxicated.
C. The cervical spine is injured until proven otherwise by imaging and clinical exam.
D. The cervical spine is likely stable because he was wearing a seatbelt.
, Correct Answer: C
Rationale: The best answer is C because in the prehospital setting, a traumatic
mechanism combined with midline cervical tenderness mandates spinal immobilization
and assumption of injury until a full evaluation can rule it out.
Q7: You are transporting a stable trauma patient with isolated orthopedic injuries to a
local hospital. The transport time is 15 minutes. Suddenly, the patient becomes
confused, his radial pulse becomes barely palpable, and his skin becomes cool and
clammy. What is the most appropriate change in management?
A. Continue transport at current speed but reassess vitals in 5 minutes.
B. Immediately divert to the nearest trauma center, even if it is past the local hospital.
C. Stop the ambulance, initiate a full secondary survey, and then proceed.
D. Increase oxygen flow rate and continue to the local hospital.
Correct Answer: B
Rationale: This choice is correct because the patient's decompensation indicates a
delayed response to injury (likely internal hemorrhage) requiring a higher level of
definitive care; the "load and go" decision must be re-evaluated based on changing
patient status.
Q8: During the secondary survey, you encounter a patient with a "seat belt sign" across
the abdomen. What specific injury should you suspect and investigate?
A. Lumbar spine fracture
B. Hollow viscus injury (small bowel)
C. Flail chest
D. Traumatic brain injury
Correct Answer: B
Rationale: This choice is correct because the seat belt sign is a marker of significant
force applied to the abdomen, which is strongly associated with injuries to the hollow
organs, particularly the small bowel and mesentery.
Q9: A construction worker falls approximately 25 feet onto concrete. He is awake but
complaining of back pain. His vital signs are stable. Why is the mechanism of injury
(MOI) significant in this case?
A. Falls greater than 20 feet are automatically considered "load and go" regardless of
vitals.
B. The energy transmission is sufficient to cause spinal, pelvic, or internal injuries
despite normal vitals.
C. MOI is only used for pediatric patients, not adults.
D. Stable vital signs rule out any significant injury from this height.
Correct Answer: B
